HAMDEN ASSURANCE RISK RETENTION GROUP INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- HAMDEN ASSURANCE RISK RETENTION GROUP INC (EIN 20-8530788)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-16
- IRS object ID
- 201503209349307375
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-16T12:48:41-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRICEWATERHOUSECOOPERS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 SEAPORT BLVD | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02210 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208530788 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hamden Assurance Risk Retention Group Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % ROBIN KILFEATHER-MACKEY | InCareOfNm |
| Business Name Control | HAMD | BusinessNameControlTxt |
| Phone | 6036531155 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 30 Main Street Suite 330 | AddressLine1Txt |
| City | Burlington | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05401 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Robin Kilfeather-Mackey | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Signature | 2015-11-16 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Paul Tanis | PreparerPersonNm |
| PTIN | P01441612 | PTIN |
| Phone | 6175305000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Robin Kilfeather-Mackey | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Medical Center Drive | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03756 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,260,283 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2007 | FormationYr |
| Legal Domicile State | VT | LegalDomicileStateCd |
| Activity Or Mission | See Attachment 1 | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 1 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $493,050 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $625,259 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,876 | PYInvestmentIncomeAmt |
| CY Investment Income | $10,345 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $498,926 | PYTotalRevenueAmt |
| CY Total Revenue | $635,604 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $394,158 | PYOtherExpensesAmt |
| CY Other Expenses | $598,242 | CYOtherExpensesAmt |
| PY Total Expenses | $394,158 | PYTotalExpensesAmt |
| CY Total Expenses | $598,242 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $104,768 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $37,362 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $93,159,928 | TotalAssetsBOYAmt |
| Total Assets EOY | $88,377,638 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $91,520,814 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $86,699,040 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,639,114 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,678,598 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO BENEFIT, TO PERFORM THE FUNCTIONS OF, AND TO CARRY OUT THE PURPOSES OF THE CHARITABLE CLASS OF BENEFICIARIES, THROUGH THE PROVISION OF SELF-INSURANCE COVERAGE AND OTHER SERVICES THAT RISK RETENTION GROUPS ARE PERMITTED TO PROVIDE UNDER THE APPLICABLE FEDERAL AND STATE LAW; TO ACQUIRE, ESTABLISH, RETAIN AND MAINTAIN A FUND OR FUNDS TO BE HELD, INVESTED AND USED EXCLUSIVELY FOR THE FOREGOING PURPOSES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $514,205 | ExpenseAmt |
| Revenue | $625,259 | RevenueAmt |
| Desc | Hamden Assurance Risk Retention Group, Inc. (Hamden) was incorporated on February 28, 2007, under the laws of the State of Vermont by its Class A members: Dartmouth-Hitchcock Medical Center, Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital and the Trustees of Dartmouth College. Commencing operations on October 1, 2007, Hamden writes medical professional and general liability coverage for its members (insureds) which are also the owners. Insurance coverage is provided through a primary and an excess policy. | Desc |
| Total Program Service Expenses | $514,205 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | Yes (true) | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBIN KILFEATHER-MACKEY | PersonNm |
| Phone | 6036505668 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE MEDICAL CENTER | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03756 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| Daniel P Jantzen | |||||||
| Vice President | 1.0 | 60.0 | Yes (X) | Yes (X) | $0 | $604,478 | $210,934 |
| Lawrence J Dacey MD MS | |||||||
| President | 1.0 | 12.3 | Yes (X) | Yes (X) | $0 | $132,136 | $230,712 |
| Robin F Kilfeather-Mackey | |||||||
| VP & Treasurer | 1.0 | 60.01 | Yes (X) | Yes (X) | $0 | $520,432 | $214,698 |
| Jeanine M Arden-Ornt | |||||||
| Secretary | 1.0 | 60.0 | Yes (X) | Yes (X) | $0 | $361,456 | $42,718 |
| Thomas A Colacchio MD | |||||||
| Chairman | 1.0 | 40.0 | Yes (X) | Yes (X) | $0 | $1,067,539 | $130,947 |
| Robert M Gagliardi | |||||||
| Director | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Paul F Greeley | |||||||
| Director | 1.0 | 40.0 | Yes (X) | $0 | $199,492 | $18,212 | |
| Randall L Wachsmann | |||||||
| Assistant Secretary | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,885,533 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $848,221 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CEDING COMMISSIONS | Desc |
| Business | 524298 | BusinessCd |
| Total Revenue Column | $625,259 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $625,259 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $625,259 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,726 | TotalRevenueColumnAmt |
| Exclusion | $9,726 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $625,298 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $624,679 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $619 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $619 | TotalRevenueColumnAmt |
| Exclusion | $619 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $635,604 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $625,259 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $10,345 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $251,626 | TotalAmt |
| Program Services | $230,696 | ProgramServicesAmt |
| Management And General | $20,930 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,522 | TotalAmt |
| Management And General | $14,522 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,222 | TotalAmt |
| Management And General | $43,222 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,727 | TotalAmt |
| Management And General | $4,727 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $636 | TotalAmt |
| Management And General | $636 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,252 | TotalAmt |
| Program Services | $1,252 | ProgramServicesAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| ACTUARIAL FEES | $137,500 | $137,500 |
| PREMIUM TAX EXPENSE | $137,355 | $137,355 |
| DUES AND ASSESSMENTS | $1,147 | $1,147 |
| LETTER OF CREDIT FEES | $5,000 | $5,000 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,255 | TotalAmt |
| Program Services | $1,255 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $598,242 | TotalAmt |
| Program Services | $514,205 | ProgramServicesAmt |
| Management And General | $84,037 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $823,188 | BOYAmt |
| EOY | $524,508 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,389,396 | BOYAmt |
| EOY | $31,469,562 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $222,867 | BOYAmt |
| EOY | $251,685 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,917,647 | BOYAmt |
| EOY | $2,074,342 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,806,830 | BOYAmt |
| EOY | $54,057,541 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,159,928 | BOYAmt |
| EOY | $88,377,638 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $196,302 | BOYAmt |
| EOY | $234,746 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $297,779 | BOYAmt |
| EOY | $327,480 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,026,733 | BOYAmt |
| EOY | $86,136,814 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,520,814 | BOYAmt |
| EOY | $86,699,040 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,050,000 | BOYAmt |
| EOY | $1,050,000 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $589,114 | BOYAmt |
| EOY | $628,598 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,639,114 | BOYAmt |
| EOY | $1,678,598 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,159,928 | BOYAmt |
| EOY | $88,377,638 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $37,362 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,122 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 5 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (4 entries)
| EINEIN | Organization TypeOrganizationTypeDesc | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| DARTMOUTH-HITCHCOCK CLINIC | ||||
| 222519596 | 0 | Yes (true) | $0 | $0 |
| MARY HITCHCOCK MEMORIAL HOSPITAL | ||||
| 020222140 | 0 | Yes (true) | $0 | $0 |
| TRUSTEES OF DARTMOUTH COLLEGE | ||||
| 020222111 | 0 | Yes (true) | $0 | $0 |
| DARTMOUTH-HITCHCOCK MEDICAL CENTER | ||||
| 222715483 | 0 | Yes (true) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 4 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Supported Org Class Designated | false | SupportedOrgClassDesignatedInd |
| Substitution Beyond Org Cntl | false | SubstitutionBeyondOrgCntlInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (true) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | false | OperateBenefitNonSuprtOrgInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Land | LandGrp | |
| Buildings | BuildingsGrp | |
| Leasehold Improvements | LeaseholdImprovementsGrp | |
| Equipment | EquipmentGrp | |
| Other Land Buildings | OtherLandBuildingsGrp |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DEPOSIT ASSET | $53,055,046 |
| LETTER OF CREDIT | $1,000,000 |
| ACCRUED INTEREST | $2,495 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $54,057,541 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DEPOSIT LIABILITY | $54,540,307 |
| PREMIUM TAXES PAYABLE | $126,945 |
| DUE TO MEMBERS AND AFFILIATES | $31,469,562 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $86,136,814 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $632,999 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $2,122 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $2,122 | RevenueNotReportedAmt |
| Revenue Subtotal | $630,877 | RevenueSubtotalAmt |
| Other Revenues Not Included | $4,727 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $4,727 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $635,604 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $593,515 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $593,515 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $4,727 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $4,727 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $598,242 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part XI | Investment expenses of $4,727, included in the revenue of HRRG's audited financial statements. |
| Schedule D, Part XII | Investment expenses of $4,727, included in the revenue of HRRG's audited financial statements. |
| ASC 740 Footnote Schedule D Part X,Line 2 | No ASC 740 footnote was included in the audited financial statements as there were no material uncertain tax positions at or since adoption. |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America and the Caribbean | RegionTxt |
| Type Of Activities Conducted | Program Services | TypeOfActivitiesConductedTxt |
| Specific Services Provided | Insurance | SpecificServicesProvidedTxt |
| Region Total Expenditures | $6,133,060 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Spent | $6,133,060 | SubtotalSpentAmt |
| Total Spent | $6,133,060 | TotalSpentAmt |
| Transfer To Foreign Corp | false | TransferToForeignCorpInd |
| Interest In Foreign Trust | false | InterestInForeignTrustInd |
| Foreign Corp Ownership | false | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | false | PassiveForeignInvestmestCoInd |
| Foreign Partnership | false | ForeignPartnershipInd |
| Boycott Countries | false | BoycottCountriesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule F, Part I, Column (f) | FormAndLineReferenceDesc |
| Explanation | The amount reported under column (f) represents the amount as accounted for within the audited financial statements of the organization. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Daniel P Jantzen | ||||||||||||||
| Vice President | $0 | $515,042 | $0 | $0 | $89,436 | $0 | $190,359 | $0 | $20,575 | $0 | $815,412 | $0 | $0 | |
| Lawrence J Dacey MD MS | ||||||||||||||
| President | $0 | $82,044 | $0 | $0 | $41,092 | $0 | $230,712 | $0 | $0 | $0 | $362,848 | $0 | $0 | $9,000 |
| Robin F Kilfeather-Mackey | ||||||||||||||
| VP & Treasurer | $0 | $500,806 | $0 | $0 | $19,626 | $0 | $194,123 | $0 | $20,575 | $0 | $735,130 | $0 | $0 | |
| Jeanine M Arden-Ornt | ||||||||||||||
| Secretary | $0 | $340,565 | $0 | $0 | $20,891 | $0 | $38,457 | $0 | $4,261 | $0 | $404,174 | $0 | $0 | |
| Thomas A Colacchio MD | ||||||||||||||
| Chairman | $0 | $648,749 | $0 | $0 | $418,790 | $0 | $116,627 | $0 | $14,320 | $0 | $1,198,486 | $0 | $0 | |
| Paul F Greeley | ||||||||||||||
| Director | $0 | $198,888 | $0 | $0 | $604 | $0 | $17,500 | $0 | $712 | $0 | $217,704 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Severance Payments | FormAndLineReferenceDesc |
| Explanation | Form 990, Schedule J, Line 4a During 2012, Thomas Colacchio transitioned from an officer role to a staff physician role. As part of this transition, Thomas Colacchio received a $320,000 change of control payment from Dartmouth-Hitchcock. The payment is included on Schedule J, Line B, Part iii. Jeanine Arden Ornt ended employment with a related organization, MHMH on 6/30/2014. MHMH engaged the former employee on a consulting basis for 12 months thereafter to assist with Risk Management and Insurance Consulting Services. Schedule J Part II, Column B(i) includes IRS Form 1099-Misc compensation in the amount of $93,594. Dartmouth-Hitchcock Defined Contribution Supplemental Retirement Plan Schedule J, Part I, Line 4b The following individuals received funds from a supplemental non-qualified retirement plan: Daniel Jantzen $73,637 Lawrence Dacey $40,914 Robin Kilfeather-Mackey $19,090 Jeanine Arden Ornt $19,862 Thomas Colacchio $98,790 Terms and Conditions: An eligible employee is a participant in the Dartmouth-Hitchcock Retirement Plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (including a qualified defined benefit plan) who would be entitled to additional contributions or benefit accruals under the terms of the plans for the plan year, but are limited by IRC Section 401(A) and/or 415. For eligible employees, the employer will pay the eligible employee an amount determined by the employer each year to offset the amount of the reduction in the benefit accrual or contributions as a result of limitations imposed by IRC sections 401(A)(17) and/or 415. Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic, both related organizations, sponsor a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable MHMH to attract and retain quality executive personnel, improve the physicians' post-retirement life insurance benefits, and to replace an increasingly costly retiree life insurance program. The plan was frozen in 1998 and therefore no further costs of the individual employee insurance premiums have been funded by the organization. The number of participants and dollar value continues to dwindle as individuals retire/leave the organization. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Board Independence | Description of Organization's Delegation of Management Control Form 990, Part VI, Line 3 The Organization has a management agreement with AIG Management Services to provide day-to-day accounting, and administrative services (such as legal and insurance registrations). The board retains all voting rights and decision making over the Organization. Description of Classes of Members or Stockholders Form 990, Part VI, Line 6 There are two classes of members: Class A Members and Class B Members. The initial Class A Members shall be Dartmouth-Hitchcock Medical Center, Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and the Trustees of Dartmouth College. Class B Members shall be entities affiliated with or related to the Class A Members. |
| Description of Classes of Persons and the Nature of Their Rights | Form 990, Part VI, Line 7a Each class A Member shall have full voting rights. The number of votes Each Class A Member Shall be entitled to cast on each matter submitted to a vote of the members shall be based on a ratio that one class A member's risk bears to risks all Class A members of the corporation as set forth in the Coporation's Bylaws, Predicated on either the class A member's first year premiums or deposits. Class B members shall, voting as a separate class, have the right to elect one Class B Director of the Corporation. Class B Members shall NOT have the right to vote on any other matters submitted to a vote of the Members, except as otherwise provided under Vermont law. Each class B Member shall have one vote for each matter on which the class B members are entitled to vote. |
| Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights | Form 990, Part VI, Line 7b The affairs of the Organization shall be managed by a Board of Directors consisting of at least three and no more than seven members of Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and the Trustees of Dartmouth College. The Class B Members shall, voting as a separate class, have the right to elect one Class B Director of the Organization. All additional members of the Board of Directors, if any shall be appointed by the Clinic, Hospital, and the Trustees of Dartmouth College. |
| Governance Over Approval and Filing of 990 | Form 990, Part VI, Line 11b An ad hoc committee including at least, but not limited to, the president and vice president, review the form before its filing and report to the board at their annual meeting. A copy of the full form 990 is given to the board before filing. |
| Conflict of Interest Policy Enforcement | Form 990, Part VI, Line 12c The Hamden Risk Retention Group's BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. THE DARTMOUTH-HITCHCOCK, OFFICE OF POLICY SUPPORT, COMPLIANCE AND AUDIT SERVICES CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS AND TRUSTEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE COMPLIANCE AND AUDIT SERVICES DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Compensation Policies Form 990 Part VI Section B Line 15A The organization's officers are compensated by Dartmouth-Hitchcock Clinic and Mary Hitchcock Memorial Hospital, both related and supported organizations of HRRG. As part of their roles at DHC and MHMH, their compensation is reviewed by external parties as well as DHC and MHMH's compensation committee. |
| Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public | Form 990, Part VI, Line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Dartmouth-Hitchcock Clinic | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 222519596 | Phys Svcs | NH | 501(c)(3) | 9 | D-H Health | Yes (true) |
| Mary Hitchcock Memorial Hospital | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 020222140 | Hospital | NH | 501(c)(3) | 3 | D-H Health | Yes (true) |
| Dartmouth College | ||||||||||
| 37 Dewey Field Road | Hanover | NH | 03755 | 222527266 | Higher Educ. | NH | 501(c)(3) | 2 | NA | false |
| Dartmouth-Hitchcock Medical Center | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 222715483 | Support Org. | NH | 501(c)(3) | 11 Type I | NA | Yes (true) |
| Dartmouth-Hitchcock Health | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 264812335 | Parent Org | NH | 501(c)(3) | 11 Type II | NA | false |
| The Hitchcock Foundation | ||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 020222139 | Hlthcre Rsrch | NH | 501(c)(3) | 7 | DHC | Yes (true) |
| The New London Hospital Association Inc | ||||||||||
| 273 County Rd | New London | NH | 03257 | 020222171 | Health Care | NH | 501(c)(3) | 3 | D-H Health | Yes (true) |
| Windsor Hospital Association | ||||||||||
| 289 Country Road | Windsor | VT | 05089 | 030183721 | Hospital | VT | 501(C)(3) | 3 | D-HH | Yes (true) |
| Mt Ascutney Hosp Cmmty Hlth Found | ||||||||||
| 289 Country Road | Windsor | VT | 05089 | 030300481 | Foundation | VT | 501(c)(3) | 3 | D-HH | Yes (true) |
| Historic Homes of Runnemede | ||||||||||
| 289 Country Road | Windsor | VT | 05089 | 237396147 | Healthcare | VT | 501(c)(3) | 9 | D-HH | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|
| Obnet Services LLC | |||||||
| 1 Med Ctr Dr | Lebanon | NH | 03756 | 043746287 | Database Serv | NH | NA |
| D-H Master Inv Prog | |||||||
| 1 Med Ctr Dr | Lebanon | NH | 03756 | 020505863 | Pooled Inv | NH | NA |
| Keene Hlth Alliance | |||||||
| 580 Court St | Keene | NH | 03431 | 300179297 | Healthcare | NH | NA |
| One Care VT ACOLLC | |||||||
| 111 COLCHESTER AVE | Burlington | VT | 05401 | 455399218 | Shared Saving | VT | NA |
| New Eng Pharm Collab | |||||||
| 1 Med Ctr Dr | Lebanon | NH | 03756 | 263819035 | Purchasing | NH | NA |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pompanoosuc Investment Corporation | ||||||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 020352330 | Rl Estate Hld | NH | NA | C Corp | Yes (true) | |||||
| Hamden Assurance Company Ltd | ||||||||||||||
| 202588083 | Liab. Ins | NA | C Corp | Yes (true) | Canons Court 22 Victoria St | HM EX | Hamilton | BD | BD | |||||
| Hitchcock Health Connect | ||||||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 800908979 | Telehealth | NH | D-H Health | C corp | Yes (true) | |||||
| Kearsarge Community Services Inc | ||||||||||||||
| 273 County Road | New London | NH | 03257 | 020460136 | Rl Estate Hld | NH | NA | C Corp | Yes (true) | |||||
| New London Medical Center East Inc | ||||||||||||||
| 273 County Road | New London | NH | 03257 | 020480857 | Rl Estate Hld | NH | NA | C Corp | Yes (true) | |||||
| New London Physician Group Inc | ||||||||||||||
| 273 County Road | New London | NH | 03257 | 020494420 | Physician Gro | NH | NA | Corp | Yes (true) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Dartmouth Hitchcock Clinic | ||
| Q | $2,414,286 | FMV |
| Mary Hitchcock Memorial Hospital | ||
| Q | $5,373,734 | FMV |
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